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Original Articles Bangladesh Journal of Anatomy January 2014, Vol. 12, No. 1 pp. 3-6 Original Articles Study of Umbilical Cord in Pregnancy Induced Hypertension with and without Diabetes Mellitus Rita Rani Saha1, Nazma Farhat2, Mallika Karmaker3 Abstract Context : Two organs that can provide a good insight into pregnancy induced hypertension with and without diabetes mellitus are the placenta and the umbilical cord along with their vessels. In the present study the umbilical cord is taken from the placenta of hypertensive and diabetic mothers to measure its diameter, to observe contained vessels and its mode of attachment to the placenta. Materials and Methods: An observational and analytical type of study was conducted in the department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between November 2003 to May 2004 on umbilical cords. To study the umbilical cord, placentas were collected from fifty eight Bangladeshi women who gave birth to a single live baby through Caesarian section after 35 to 40 weeks of gestasion. Twenty of the mothers were non hypertensive, non diabetic control, twenty had pregnancy induced hypertension(PIH) and eighteen had pregnancy induced hypertension and gestesional diabetes mellitus(PIH+GDM). Results: No significant difference was found between any groups for diameter of the umbilical cord. All the umbilical cords had same number of vessels. There was variation among the mode of insertion of umbilical cord. Conclusion: Diameter of umbilical cords did not show significant difference in either of the two diseased groups with the control group in the Post Hoc option of analysis of variance (ANOVA) at 5% level. Key words: Umbilical cord, pregnancy induced hypertension, gestational diabetes mellitus. Introduction battledore placenta , and its attachment to the fetal The placenta is the primary site for nutrients and membranes is a velamentous insertion of the cord2. gaseous exchange between mother and fetus. Both The umbilical cord is usually 1 to 2 cm in diameter the placenta and the umbilical cord functions as a and 30 to 90 cm in length (average 55cm). transport system for substances passing between Excessively long or short cords are uncommon. mother and fetus. The vessels in the umbilical cord There are usually two arteries and one vein in the connect the placental circulation with the fetal umbilical cord that are surrounded by mucoid circulation. connective tissue (Wharton Jelly). The umbilical arteries are spirally arranged and present thick wall. The attachment of the umbilical cord to the placenta In the early part of pregnancy the umbilical veins is usually near the centre of fetal surface of this are two in number. Later the right umbilical vein organ, but it may attach at any point. For example, disappears and the left one persists to convey insertion of it at the placental margin produces a oxygenated blood from placenta to the fetus. Nerves are not detected in the umbilical cord3. Colour flow 1. Professor (C.C) Department of Anatomy, Shaheed Monsur Doppler ultrasonography may be used for the Ali Medical College, Dhaka. 2. Assistant Professor, Department of Anatomy, Shaheed prenatal diagnosis of the position and structural 2 Monsur Ali Medical College, Dhaka. abnormalities of the umbilical cord and its vessels . 3. Assistant Professor, Department of Anatomy, Shaheed Monsur Ali Medical College, Dhaka. Both umbilical cord and placenta are morphol- Correspondence : Dr. Rita Rani Saha. ogically adapted to the essential function of bringing Bangladesh J. Anat. 2014; 12(1) : 3-6 fetal and maternal blood streams in close diameter by resistered doctors of the departments association in normalcy. Among the high risk of Gynecology and Obstetrics or by registered pregnancies, hypertensive disorders are the most ultrasonologists respectively. common medical complication of pregnancy and a major cause of maternal and perinatal morbidity and Operational definitions and grouping death4. Pregnancy-induced diabetes mellitus or Control group gestational diabetes mellitus (GDM) also This group comprised of twenty mothers who did complicates the pregnancy and is associated with not show any of the common exclusion criteria congenital malformation, intrauterine death, perinatal mentioned above and were non-hypertensive and and maternal mortality and morbidity5. Like other non-diabetic. developing countries, Bangladesh still has alarming maternal and fetal mortality rates. Compensatory Pregnancy-induced hypertension (PIH) changes, therefore, are likely to occur in these The mothers of this group had hypertension with organs in disease situations. Changes in the first recognition during the present pregnancy. The morphology of umbilical cord component is, diagnosis of hypertension was made by measuring therefore, considered as area of real importance and the blood pressure of > 140 and/ or > 90 mm(hg) nd interest with implications in both basic and clinical during the 2 half of the pregnancy that had research. manifested at least twice > 6 hours apart5. Diabetes mellitus and the common exclusion criteria already Material and methods mentioned were absent. Selection of specimens (placentas with umbilical cords) PIH with gestational diabetes mellitus (GDM) The mothers of this group developed hypertension A total of fifty eight umbilical cords were examined, and hyperglycemia during the present pregnancy all from live births. All the specimens were collected and were normotensive, non diabetic before this from the pregnant women whose deliveries were pregnancy. conducted through cesarean section in the departments of Gynecology and Obstetrics Procedure of studying the variables of the Departments of BSMMU and BIRDEM hospitals. umbilical cord Among these, twenty placentas were collected from 1) Diameter of the umbilical cord normotensive and normoglycemic mothers as On the cut surface of the umbilical cord, the control, twenty placentas were collected from maximum diameter was measured with a metallic mothers having pregnancy induced hypertension scale. Then the second maximum diameter was (PIH) and eighteen placentas were collected from taken at right angles to the first one. Lastly, the mothers having pregnancy induced hypertension mean diameter of the umbilical cord was calculated (PIH) along with gestational diabetes mellitus from these two measurements3 (GDM). 2) Number of umbilical vessels The diagnosis of the clinical conditions and other The number of each of the umbilical vessels (artery clinical assessments of the patients were confirmed and vein) was counted and recorded. by the registered doctors of the department of Gynecology and Obstetric of BIRDEM and BSMMU 3) Mode of insertion of the umbilical cord hospitals. The patients delivered babies between The insertion of the umbilical cord was recorded the 35th and 40th weeks of gestation through as “central” when it was attached at the center or Caesarian section. Only the babies of severe PIH within 2 cm of the center of the placenta. When cases were delivered before 37 weeks of gestation the cord was attached at or within 2cm of the Gestational age was calculated in early pregnancy placental margin, it was recorded as a “marginal” using the 1st day of the last menstrual period or or “peripheral” insertion. “Intermediate” position was from ultrasound measurement of the biparietal recorded when the cord was inserted at any point 4 Bangladesh J. Anat. 2014; 12(1) : 3-6 between the central and marginal point of attachment. Intermediate and marginal insertions were together termed as “ecentric insertion”4. “Vellamentous” insertion was recorded when the umbilical cord was inserted on the fetal membranes. Results Macroscopic variables of the umbilical cord: Mode of insertion of umbilical cord: Table-I shows mode of insertion of umbilical cord in three different groups. Percentage of central insertion was found larger in the control group. Hypertensive groups showed more eccentric insertion than the control group. Among 58 placentas only 3 placentas of PIH & PIH + GDM groups showed villamentous insertion of umbilical cord. Table-I Fig.-1: Bar diagram showing mean diameter of the Frequencies of different modes of insertion of umbilical cord in three different groups of subjects. umbilical cords into the placenta in different Control: Non-diabetic, non-hypertensive groups PIH: Pregnancy-induced Hypertension GDM: Gestational Diabetes Mellitus Variable Control PIH PIH +GDM n=20 n=20 n=18 Discussion According to Pansky7, Sadler8, Moore2 the Central 10 (50%) 9 (45%) 8 (44.44%) diameter of the umbilical cord is about 1-2cm . In Intermediate 6 (30%) 5 (25%) 5 (27.77%) the present study the mean diameter in all the Marginal 4 (10%) 4 (20%) 4 (22.22%) groups are (1.16 ± 0.36), (1.04 ± 0.17) and (1.06 ± 0.24) in control, PIH and PIH+GDM group Vellamentous 2 (10 %) 1(5.55 %) respectively. The mean diameter in case of control Statistical analysis was not done. group has similarities with the study of Akhtari Afrose9, Laila perveen Banu10, Rafiqul Alam11 and Control: Non-diabetic, non-hypertensive Mallika Karmaker12. In case of hypertensive and/or PIH: Pregnancy-Induced Hypertension diabetes mellitus mean diameter of umbilical cord GDM: Gestational Diabetes Mellitus differ at nonsignificant level from the control group. But diameter of umbilical cord was significantly larger Diameter and number of the vessels of the umbilical in the fetuses of mothers with geststional diabetes cord: mellitus in the study of Weissman Jakobi13, which 12 Diameter of the umbilical cords did not differ has similarities with the study of Mallika . In case significantly in both the PIH and in the PIH with of study of Rafique11 the cord diameter was more GDM groups as compared with the control group. or less similar in both prolonged diabetic and All the umbilical cords had two arteries and one gestational diabetic groups and also in control vein. Figure 1 represents the mean diameter of the group. umbilical cord in three different groups of the Regarding the number of the umbilical vessels, 2 subjects. arteries and 1 vein were found in all the samples of 5 Bangladesh J. Anat. 2014; 12(1) : 3-6 the present study which have the similarities with 2.
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